Provider Demographics
NPI:1649624248
Name:DVORAK, JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:DVORAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1450 NW 6035
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55485-1450
Mailing Address - Country:US
Mailing Address - Phone:866-674-7933
Mailing Address - Fax:952-513-6880
Practice Address - Street 1:5775 WAYZATA BLVD STE 190
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2627
Practice Address - Country:US
Practice Address - Phone:952-541-1840
Practice Address - Fax:952-543-6524
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MN64568208VP0000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine